(Just a reminder that comments are from THIRD PARTY experts, NOT study authors, unless otherwise stated.)

Contact: Michael Kaplan, xxx-xxx-xxxx

See comments from Dr. Mark Fromer, ophthalmologist at Lenox Hill Hospital in New York regarding Monday’s embargoed study in JAMA Internal Medicine that finds regular aspirin use appears to be associated with an increased risk of neovascular age-related macular degeneration (AMD), which is a leading cause of blindness in older people, and it appears to be independent of a history of cardiovascular disease and smoking.

Please let me know if you would like to speak with Dr. Fromer.

According to Dr. Fromer:

The email continues with comments from Dr. Fromer about a study that was scheduled to appear in JAMA Internal Medicine.

Such emails — and my inbox contains more than 300, dating back to March 2011 — come from Michael Kaplan, of GCI Health, a PR firm that represents North Shore-LIJ, a collection of community and teaching hospitals in New York. Among those hospitals are North Shore, Long Island Jewish, and Lenox Hill, all of whose experts have been featured in Kaplan’s pitches, available to comment on studies in the JAMA family of journals, the BMJ, Pediatrics, and the New England Journal of Medicine.

Kaplan’s approach seems to work. Last month, HealthNewsReview.org reviewed two stories about berries and stroke in women. In one review, they noted:

The story quotes two independent experts, preventive cardiologist Dr. Suzanne Steinbaum and nutritionist Dana Greene. We wish that the experts were quoted on a more analytical view of the study, instead of talking so much about berry diets. Greene is even quoted as saying, “[Berries] are so good for you,” and “There is no downside” to eating berries. Again, too much of anything could become more of a harm than a benefit, as mentioned above. It’s interesting that Steinbaum was also interviewed in the competing TIME story. Why?

Steinbaum works at Lenox Hill Hospital and was the subject of a Kaplan email three days before the study was published. Know why she appears in both stories now?

I have to admit the approach is a pretty good way of making sure outside comments make it into stories that need them. A lack of such comments is one of the problems HealthNewsReview.org points out frequently.

But there are some problems with the method. Kaplan’s emails include specifics about embargoed studies, and I never signed an embargo agreement with him. And how is he getting access to these embargoed studies to begin with? Don’t journals restrict such access to journalists, right or wrong, who agree to their embargo policies?

For instance, EurekAlert, a major clearinghouse of embargoed news run by AAAS, doesn’t give anyone but reporters access, the service’s Jennifer Santisi confirmed for me this morning:

Embargoed access to EurekAlert! is not extended to PIOs– reporter registration for embargoed content is reserved for full-time freelancers and reporters. Registrants are vetted by EurekAlert!’s editorial staff to ensure that reporters do not also hold research or press officer positions at universities. PIOs subscribed with EurekAlert! may only see their own institution’s press releases that were submitted by that institution’s press office.

I went to Kaplan to find out more details, and he referred me to North Shore’s vice president of public relations, Terry Lynam. In a candid conversation yesterday, Lynam told me Kaplan had been working with Lenox Hill for at least a decade, and with North Shore for about two years.

Lynam wasn’t sure how the hospitals and Kaplan were getting access to embargoed studies. That surprised me, given his position. He said the hospitals’ libraries received the journals. I pointed out that libraries might have access to published studies, but not to embargoed studies, and he said, again candidly, that he wasn’t involved in the details of how they’re acquired.

A phone call to Jann Ingmire, director of media relations at the JAMA Network, sorted it out for me. It turns out JAMA has a different policy than EurekAlert. Ingmire said the journal sends embargoed material to medical school and hospital PR offices whose researchers tend to publish studies. North Shore’s director of media relations — one of Lynam’s colleagues — is on that list.

The idea is to give them a heads-up about their institutions’ work, but they send all of the studies they’re publishing, not just those that involve their researchers. If that information is occasionally used to pitch outside experts, so be it:

It’s not unusual for local hospitals to pitch their own as experts. What’s different here is that they’re using a PR agency, and we would never give them access.

So perhaps that’s a nuance that got lost somewhere in translation. But whether North Shore is abusing a favor isn’t the only problem here. Ingmire:

What troubles me the most is that we never gave anyone permission to further distribute our embargoed content, and he’s putting embargoed results in an email. If you said you had whomever Dr. Ophthalmologist to comment on a new study about aspirin and AMD but you didn’t name the journal and didn’t give the embargo time or any specific results, OK.

It would even be alright to include that much in an email to a single reporter Kaplan had ensured was on the JAMA embargo list, Ingmire said, although how he’d do so is unclear. But sending this kind of detail to dozens of reporters — that was the figure Lynam gave me — “is really problematic,” said Ingmire:

They are essentially breaking the agreement, taking advantage of having early access to information that we’ve provided to them as a courtesy because they have researchers on staff, not so they could pitch them as outside experts.

Lynam said they were very careful about embargoes, noting the time in capital letters right in the subject line:

There has never been a broken embargo.

The rationale for the approach, which Lynam acknowledges his team hasn’t perfected yet, will be familiar to many PIOs:

We had a desire to be a bit more proactive in getting our physicians and experts out there. The model isn’t just identifying potential spokespersons for studies coming out of the JAMAs, the Lancets, et cetera. We’re also trying to develop a better process of promoting our own studies. Our challenge is quite frankly more internal. We’re finding out about studies after they’re already published.

Other hospitals, playing closer to the rules, might wish they had thought of this strategy before. But I wonder if this isn’t the scientific embargo version of insider trading. GCI tells visitors to its website that “we are constantly pushing boundaries to help our clients succeed.” When it comes to embargoes, GCI’s slogan is perhaps more accurate than they intended.

Ingmire says:

We all want the research to get the attention it deserves, and I don’t have a problem with getting one of their docs to comment, just not this way.

5 Responses

My interest in this debate is as a PIO who promotes work done by American Cancer Society scientists (and less commonly, our grantees) appearing in journals like NEJM. I think the line should be drawn at authorship. Promoting the work of your own scientists in cooperation with the journal makes sense. Promoting outside experts using embargoed information feels wrong in a couple ways. Primarily, it’s not your information to promote. And secondarily, it’s promotion gone wild. Pushing boundaries, indeed. But sometimes boundaries exist for a reason.

I share some of the unease with the sharing of study contents, but I also think these emails are helpful and serve a purpose. It would be better if the journals themselves provided a way for experts who did not conduct a study to reach reporters who had already agreed to the embargo.

This is aside from whether embargoes are really a good thing. The worry that they lead to real insider trading — not some metaphorical scientific embargo version — is a big issue, and I think it’s not uncommon for Wall Streeters to get ahold of actual embargoed manuscripts. But I don’t think these emails actually make that problem worse. (I’m also often puzzled that stocks frequently don’t move before the embargo lifts — evidence that maybe the system is less leaky than it appears.)

If we’re going to have an embargo system, it would be far better if 10 or 15 such emails appeared in reporters’ inboxes before a study appeared. (I’ve used Kaplan’s sources and some of them are great.)

Leaving aside the discussion of the embargo system, maybe there is a way here to centralize these sort of pre-comments in the age of the internet to add needed context to stories, as Matt Herper suggests? The big worry is that that all of it will all be fatuous praise of the study rather than genuinely critical comment, especially if the activity is captured by the journals.

Perhaps this could be a function of the ‘Science Media Centre’ discussed for U.S. reporters. I wouldn’t use it, but perhaps it could help out the general assignment types more often now assigned to medical coverage.

The embargo issue aside, frankly Ivan, to my mind this strategy is pretty Mickey-Mouse. It feeds the needs of lazy reporters who don’t want to do the legwork to find experts on their own, and offers a gift to docs/experts who didn’t have any role in the reported research. This kind of effort offering a “reaction to” research by folks not a part of the project is used consistently by many institutions whose success in getting their own research published is rare. Commenting on the work of others is an easy way to get attention and doesn’t require a lot of effort or knowledge. It’s the kind of activity I never allowed when I was running my PIO shop. I know that this is the same mindset that supports ProfNet, HARO, and some other services but it never seemed right to me.

And yes, I’d consider this a definite embargo break if I was making the decision. I would hope that the JAMA Network would take the appropriate action.